Patients with COPD often under-report symptoms of acute exacerbation. Regularly ask patients at clinic visits about escalation of symptoms; ensure they understand the difference between the expected day-to-day variation in symptoms and symptoms heralding a COPD exacerbation. Advise patients to seek clinical advice if they experience fever, worsening of their respiratory status beyond usual day-to-day variation, and/or a significant increase in their production of purulent sputum.
Advise any patient with diabetes taking systemic corticosteroids for an acute exacerbation of COPD to closely monitor their blood glucose and seek medical advice if it is outside the target range.
In any patient prescribed antibiotics for an exacerbation:
Give advice about possible adverse effects of the antibiotic, particularly diarrhoea.
Explain that symptoms may not be fully resolved when the antibiotic course has been completed. Give the patient/their family specific advice about when to seek further medical help, in particular if:
Symptoms worsen rapidly or significantly
Symptoms do not start to improve within an agreed time (e.g., 2-3 days if taking antibiotics)
The patient becomes systemically very unwell.
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